Antiretroviral Therapy PPT Presentation
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Transcript Antiretroviral Therapy PPT Presentation
ANTIRETROVIRAL THERAPY
Dr. Samuel Mwaniki
(BPharm., MSc TID, UoN)
University of Nairobi
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Definition of ART
Treatment with antiretroviral medicines,
against the retrovirus (HIV), which resides and
multiplies within the human body
HIV; etiological agent of AIDS
Hallmark of HIV; RNA virus that transcripts
DNA from RNA via the Reverse Transcriptase
enzyme
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Classification of
Antiretroviral medicines
NRTI (Nucleoside Reverse Transcriptase Inhibitors)
NtRTI (Nucleotide Reverse Transcriptase Inhibitors)
NNRTI ( Non-Nucleoside Reverse Transcriptase
Inhibitors)
PI (Protease Inhibitors)
Entry Inhibitors
Integrase Inhibitors
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NRTIs
Abacavir (ABC)
Didanosine (DDI)
Emtricitabine (FTC)
Lamivudine (3TC)
Stavudine (D4T)
Zidovudine (AZT)
Tenofovir (TDF) - NtRTI
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NNRTIs
Efavirenz (EFV)
Nevirapine (NVP)
Etravirine
Rilpivirine
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PIs
Atazanavir (ATV)
Durunavir (DRV)
Fosamprenavir (f-APV)
Indinavir (IDV)
Lopinavir (LPV)
Nelfinavir (NFV)
Ritonavir (RTV)
Saquinavir (SQV)
Tripranvir (TPV)
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Other ARVs
Entry inhibitors: Enfuvirtide,
Maraviroc
Integrase inhibitors: Raltegravir,
Elvitegravir
Maturation inhibitors: Beviramat
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Uses of ART
ART (Antiretroviral Therapy)
PMTCT (Prevention of Mother To
Child Transmission)
PEP (Post Exposure Prophylaxis)
PrEP (Pre Exposure Prophylaxis)
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ART
Combines at least 3 ARVs from at least 2
different classes.
Why combination?
Synergism
Reduced toxicity
Prevent resistance
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ART Combinations
2 NRTI + 1 NNRTI
1 NRTI + 1 NtRTI + 1 NNRTI
2NRTI + boosted PI
1 NRTI + 1 NtRTI + boosted PI
3 NRTI (One must be Abacavir)
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Goals of ART
Maximal and durable suppression of viral replication
to prevent development of HIV, drug resistance and
treatment failure
Restoration/ preservation of immunologic function
Reduction of HIV-related morbidity and mortality
Improvement of the patient’s quality of life
Prevention of onward transmission of HIV infection
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Indications of ART
Indicated in all HIV-positive adults and adolescents with
the following:
WHO clinical stage 1 or 2 and a CD4 count ≤ 350
cells/mm3,
WHO clinical stage 3 or 4 regardless of CD4 count,
HIV and TB co-infection regardless of the CD4 count,
HIV/HBV co-infection with evidence of active liver
disease.
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First line ART regimens
Recommended first-line
antiretroviral regimens in treatment
of naive adults and adolescents are:
TDF + 3TC + EFV or NVP or
AZT + 3TC + NVP or EFV
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Changing to second line
Treatment failure
Clinical
Immunological
Virological
Inability to tolerate a drug because of
adverse effects
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Second line ART
regimens
Recommended second-line for patients failing
first line therapy
First-line
Second-line
TDF + 3TC + EFV or NVP
AZT + 3TC + LPV/r or ATV/r
AZT + 3TC + EFV or NVP
TDF + 3TC + LPV/r or ATV/r
d4T + 3TC + EFV or NVP
TDF + 3TC + LPV/r or ATV/r
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MTCT
MTCT accounts for more than 90% of pediatric HIV
infection.
Risk factors for MTCT:
Maternal (high viral load, advanced HIV disease, mixed
feeding )
Obstetric (Vaginal delivery, prolonged rupture of
membranes >4 hours, placental infection)
Infant (prematurity <37 weeks, low birth weight, oral
candidiasis)
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Interventions to reduce
MTCT
Prevention of HIV Infection among all women of
reproductive age group from getting HIV
Prevention of unintended pregnancies among HIVpositive women
Effective interventions to reduce HIV transmission to
infants during pregnancy, labor, delivery and post.
Chronic care and support for the HIV-infected
women, their infants, partners and families
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PMTCT ART regimens
When to start:
CD4 ≤350 cells/mm3 irrespective of clinical symptoms
OR
WHO clinical stage 3 or 4 irrespective of CD4 cell count
What to start:
As adult/adolescent first-line
AZT preferred but TDF acceptable
EFV included as a NNRTI option (not in first trimester)
Infants: NVP, 3TC or AZT.
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PEP
Indications for PEP
Occupational exposure (healthcare workers,
police)
After RTA where there has been exposure to
other people’s blood
Discordant couples following condom bursts
Rape
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PEP regimens
AZT/3TC: 1 bd for 28 days
TDF/3TC: 1 od for 28 days
Add Alluvia/ Kaletra: 2 bd for 28 days in case of high
risk
Given at earliest possible opportunity, within 1-72
hours of exposure
Use fixed dose combination to enhance adherence
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PrEP
Studies carried out to evaluate efficacy
iPrEx study– Preexposure Prophylaxis Initiative
Multinational (Peru, Ecuador, South Africa, Brazil,
Thailand, United States)
Effect of FTC/TDF compared with placebo on
reducing HIV acquisition among men and transgender
women who have sex with men
Disproportionately affected by the epidemic
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Thank you
END
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